Now that the Republicans control both the presidency and both houses of Congress, they must put up or shut up on their promise to repeal and replace Obamacare. Here is a flat-footed prediction: the effort will fail for three reasons. First, the Affordable Care Act (aka the ACA or Obamacare) has largely succeeded not failed, as president-elect Trump and other Republicans falsely allege. Second, it is impossible for the stated goals of repeal to be achieved. Finally, the political fallout from the consequences of partial or total repeal would be devastating. When it comes to casting votes, enough Republicans will conclude that repeal is a bad idea and will join Democrats to sustain the basic structure of the health reform law.